About complications in patients with oral cancer When chemotherapy and radiation of the head and neck
When chemotherapy and radiation of the head and neck
Introduction
This article examines the side effects associated with processors tumors on the oral tissues, where such a processor intensive destruction of cancer cells either by the toxic effects of drugs, chemical, or direct radiative forcing on the composition of the cell of the fabric of cancerous tissue, and in turn affect these treatments negatively on some cells of the body's natural , and the longer the cells and tissues, consisting of parts of the intestinal tract including the mouth, the more tissue vulnerable, in particular, given the sensitivity and nature of the cells that grow and multiply at a rapid pace, and being the stages of renewal and replacement of a continuous, and include these complications in the use of chemotherapy and radiation treatments the emergence of infections of the mucous membrane, and dry mouth and lack of sense of taste, feeling and frequent pain, in addition to the problems of infection, and nutritional deficiency as a result of malnutrition.
And there are many factors that give rise to such complications, the most important of the harm suffered by the tissues of the mouth, and a weakened immune system, in addition to the weak recovery processes natural result of the processors, so you may make these complications continue to receive treatments is difficult for the patient, which may call for a moratorium or delay in some cases.
It is worth noting that you can not prevent complications of the mouth all the time, and require the management of these complications when treating cancer, determine the extent to which they arise in the patient since the beginning, and to take immediate preventive measures before starting treatments, and then the management of complications once they arise.
Description and Etiology
May arise complications sharply (and it shows while receiving treatment), or be chronic and continuous (extending for months or years after the end of treatment), and the usual cause of chemotherapy complications of acute recovering after the treatments, while it can cause radiation therapy, in turn, the emergence of severe complications, but he's more responsible for the damage sustained tissue, which in turn causes chronic complications.
And affects both chemotherapy and radiation treatments on the ability of cells to divide and regenerate, thus hindering the process of reform and restoration of the self and the slow progress, but the open mouth ulcers arise even bigger when you receive chemotherapy, suffer more than 50% of the patients serious injury requiring medical treatment, including changing the treatments used, modified, and in most cases, these complications begin to emerge during the period of two weeks following the start of treatment, and will continue until the return rates of the blood to normal levels.
While it is possible to radiate the areas of head and neck, causing the emergence of the same problems of chemotherapy, in addition to that harm blood vessels, and parts of cartilage, and salivary glands, and muscles of the jaws and neck as well as the bones, which hurts the glands that secrete saliva, causing dry mouth and the ills of the teeth and oral cavity and hurting muscles or bones of the jaw and neck, causing osteoporosis, it causes harm radiation shortages in the supply of blood and oxygen to the bone, leading to disclose and dissolution of tissue, and may result in all of these effects, of course, to the emergence of infection and pain.
And generally do not happen like this harm only placements exposed to the radiation field of treatment, and may vary over the hurt on the type and amount of radiation used and the dose college received and the size of the area irradiated, and it should be noted that the damage caused by radiation therapy at various normal tissues remains a durable, and easy to become affected by these tissues in the later times when the use of drugs or radiation due to loss of the ability to self-restoration, natural and permanently.
Preventive measures
Measures before the start of treatment
Can reduce complications that affect the oral cavity to take preventive measures, comprehensive before starting treatments, and include preliminary measures to maintain good nutrition and balanced, and good cleaning, as well as teaching the patient how and the importance of oral care and dental and maintain their health, and investigate any mouth and problems addressed, and should, of course, offer the patient the dentist Malam complications of chemotherapy and radiation, in order to address any problems of the teeth or gums, and before the period of direct processors of cancer enough to allow recovery from the effects of dental treatment.
Measures after the treatments
Reduce health care, good oral and dental significantly the severity of the effects of cancer treatments, including cleaning, cleansing, good for the mouth all the time, and especially after meals, and scrub brush and the use of threaded Sunni to remove plaque between the teeth, and should choose oral care products carefully , it is necessary to avoid species that can injure sensitive tissue, where it may cause mouthwashes that contain alcohol, and different flavors of toothpaste in the irritation of the tissues and causes burning the gums, so prefer to always use the pastes palliative, such as pastes for children, and may not be enough to remove plaque rinse mouth and Altamadamad Balgsolat only, especially when the patient suffers from dry mouth, as these sediments are heavier and thicker, thus necessitating the use of brushes and sticks teeth or threads Sunni or scanners teeth (a sponge mounted on wooden skewer), and which are also used to clean the palate and tongue, and should always maintain the moisture lips using lip moisturizers.
Mucositis and stomatitis
Different oral infections on the inflammatory mucosa, and to use the same expression to describe both, which is limited to infections of the mucous membranes (Mucositis) of these membranes, and show a color reddish-like lesions burns, while the included stomatitis (Stomatitis) gums and teeth as well, in addition to the emergence of infection, tissue mouth, and show inflammatory mucous membranes is unusual in a period ranging between seven to ten days following the start of treatment, and from the usual to recover without treatment within two weeks to four weeks in the absence of infection, and supports appropriate treatment for these infections on the severity of and white blood cell count, and focused attention on the cleansing and good symptom relief, and include cleaning the mouth and gently smooth and moisturize the mouth and lips, and relieve pain and swelling.
And should be cleaning the mouth and teeth every four hours and before bedtime, and the pace over the intense inflammation, and useful survey gently using a piece of gauze sterile Mgamsh in brine to remove the particles sticking to teeth, which may be brushes harsh on some places, and prefer to use a brush teeth smooth.
And there are many liquid disinfectants can be used, such as the composition of salt and soda (half a teaspoon of salt, two tablespoons of sodium bicarbonate dissolved in about a liter of water), and ordinary salt (normal saline), and sterile water, or a solution of sodium bicarbonate (about a teaspoon in a quarter liter of water), and mouthwashes often cleaned and moistened tissue and prevent plaque and gum sores and living membranes, and prevents the use of time from a pool of bacteria, while the solution of salt and soda neutralize acid and dissolve thick saliva, refreshments can also be used with water-soluble gel to moisturize the mouth, and on the other hand there are several topical medications that can be used if inflammation is severe, and of course it is necessary to remove any particles stuck by the development of these medications or ointments on the gums or inflamed tissue.
Dry mouth (Xerostomia)
Result in saliva and important functions in the processes of taste and swallowing and speaking, and created a dry mouth when they can not salivary glands for secretion of sufficient quantities and of natural saliva, and symptoms include in addition to drought, burning sensation, especially on the tongue, which show obvious changes its surface, and cracking of the lips , and injure or cracked corners of mouth, and difficulty drinking liquids.
And result in dry mouth because of the effects of radiation treatment area on the head and neck salivary glands, and from the usual to begin production of saliva to fall sharply during the week of the start of treatment, and the rate continues to decline as long as the radiation sessions, and these effects arise, such as fast and can not be reversed, that is, its impact lasts special glands exposed directly to radiation, and adopt the severity of drought, of course, the radiation dose used and the number of glands irradiated, and the usual in particular that the affected salivary glands (parotid glands)'s more (and are the glands salivary glands at the top of the back of the cheek), and of course, the burden is on the salivary glands is affected to work more effectively, to compensate for the missing quantity of saliva.
And cause drought in the emergence of changes in ability to neutralize acids, mouth, and more difficult to clean the teeth and gums, and mouth protection from infection, and could lead to ulcers and gum disease different, and usually arise from the following changes:
Saliva loses moisture and becomes property of the sticky and thick.
Acids can not be the equation of the mouth and teeth begin losing the minerals, and increases the production of more acid foods or liquids, high sugars, and minerals has increased, leading to tooth decay.
The emergence of oral bacteria cause disease more easily.
Sediments become thicker and heavier, and the remaining bits of food between the teeth and mouth.
The following suggestions are useful to preserve the health and oral hygiene is always good to minimize the effects of these complications:
Cleaning the mouth and cleaned four times a day at least.
Rinse mouth with salt and soda from four to six times a day (half a teaspoon of salt, two tablespoons of sodium bicarbonate dissolved in about a liter of water), or a solution of sodium bicarbonate (one teaspoon in about a quarter liter of water).
Avoid foods and fluids high in diabetes, and eating soft foods easy swallowing.
Avoid spicy foods, spices and bitter and spicy and salty foods and coarse.
Increased rates of liquids, and water resorption Time To relieve dry mouth, and maintain moisture on the mucous membranes are durable, and can be de-absorption of hard candy sugars, or non-sweetened chewing gum, or ice chips.
The taste (Dysgeusia)
The taste is (changes in sense of taste and Alttam) of the common complications when chemotherapy and radiation of the head and neck, and the patient may suffer from the taste of unpalatable as a result of the spread of drugs to the tissues of the mouth, and changes in taste different flavors such as sweet and acid and salt, and in most cases, these effects disappear during the period of two to three months after the treatments.
And lead problem has taste turn to anorexia, which affects the diet of the patient, and it becomes necessary to modify the composition of the diet and, as appropriate, changes emerging sense of taste, and add snacks between meals to help cover the food needs, and consult an expert diet may be necessary during and after receiving the treatments ended.
The growth of teeth
Are changes in the growth and development of the teeth of the usual problems in the long term when the children receive high-dose chemotherapy, radiation treatments or receiving head and neck, and usually show changes in the size and shape of teeth and delayed emergence, in addition to the lack of growth of the head and the face in reaching full maturity, and it should be noted that there is no adequate studies on the extent of the role they may play orthodontic treatments, or the appropriate timing, the emergence of these changes in children and treatments resulting from the tumor stages and different patterns.
Infection
Become oral infections more difficult and complicated with the emergence of infection, especially when low capacity of the immune system, and the continued destitution white blood cells for prolonged periods and increased risk of developing infections, and when worsening as the presence of side effects and inflammation may become mouth contaminated and are easy to catch the infection through the tissues affected, allowing tissue inflamed mouth of the organism causing the disease to enter the circulation, including the bacteria is not harmful become a dangerous turn in such a case, and can use of drugs, of course, to prevent fungal infection, such as mouthwashes that contain anti-fungal , it becomes pure surface infection only, and can not be absorbed and do not help in the treatment of infection deeper than that, such as the esophagus or intestinal infection, and should therefore be dealt with the use of medications by mouth or by intravenous injection to treat infections of the mouth.
Bleeding
Arises when the bleeding tumor treatments weaken the ability of blood clotting in Bzbbha low platelets, and may bleed when the positions of infected gum Taathaj, and that happens usually with lower rates of blood to certain levels, and has small red spots appear on the lips, or ceiling the bottom of the throat and the mouth or around the teeth, and the patient can clean the teeth or dental yarns during periods of high rates of blood counts, and that the use of a solution of 3% hydrogen peroxide and salt water helps to clean the wounds that have been used carefully.
Fatigue
Patients with cancer fatigue is unusual, whether the effects of the disease or the result of receiving processor-intensive and high doses, both treatments chemotherapy and radiation, and may be difficult for the patient follow-up routine oral care at the suffering of fatigue constantly, and become vulnerable to the risk of ulcers of the mouth and infection and the emergence of different pains.
(Please go to a page that fatigue to see more details about its effects).
Psychological and social considerations
Affect complications mouth adversely the ability of the patient to eat and speak, and may turn to the difficult problem affecting aspects of psychological and social has, not surprisingly, become some patients are disappointed by these complications, and suffer from introversion and isolation and depression, and avoid contact with others , and of course drugs are not an option in the treatment of depression, such as this case, since the side effects that could worsen the problems of the mouth and make it more difficult.
It is necessary to monitor the patient's ability to deal with the complications and extent of response to treatments, and provide supportive care and intensive education and necessary, both from the medical team or family.
